Study Questions:

Methods:

Data from adults (ages 30-79 years of age) residing in 10 diverse regions (five urban and five rural) of China were included in the China Kadoorie Biobank Study. Participants were enrolled between 2004 and 2008. A total of 512,891 participants were included in this study, of which only those without a history of CVD or who did not report antihypertensive medication use were included. Dietary data on 12 major food groups were collected through self-report. Participants were asked how often they consumed foods over the past 12 months. The primary outcomes of interest included CVD events including myocardial infarction, ischemic stroke, and hemorrhagic stroke. Information on blood pressure was also collected through local study clinics.

Results:

A total of 451,665 participants were included in this analysis. Over 3.2 million person-years of follow-up, 5,173 deaths from CVD, 2,551 incident major coronary events (fatal or nonfatal), 14,579 ischemic strokes, and 3,523 intracerebral hemorrhages were recorded. Almost 20% of participants reported daily intake of fresh fruit. Those who reported daily intake of fresh fruit had lower systolic blood pressure (by 4.0 mm Hg) compared to those who reported rarely or never consuming fresh fruit. A similar association was observed for blood glucose. Increased risk was observed for individual outcomes compared to daily fruit consumption versus nonconsumption including hazard ratio (HR) = 0.60 (95% confidence interval [CI], 0.54-0.67) for CV death, HR = 0.66 (95% CI, 0.58-0.75), 0.75 (95% CI, 0.72-0.79) for incident major coronary events, HR = 0.75 (95% CI, 0.72-0.79) for ischemic stroke, and 0.64 (95% CI, 0.56-0.74) for hemorrhagic stroke. There was a strong log linear dose–response relationship between the incidence of each outcome and the amount of fresh fruit consumed. These associations were similar across the 10 study regions and in subgroups of participants defined by baseline characteristics.

Conclusions:

The investigators concluded that among Chinese adults, a higher level of fruit consumption was associated with lower blood pressure and blood glucose levels, and with significantly lower risks of major CVDs.

Perspective:

These data suggest that a healthy diet including fresh fruit is associated with lower blood pressure and lower risk for CVD.